When you have diabetes, it is recommended for your wellbeing that you have a dilated eye exam every 1-2 years to screen for diabetic retinopathy, which is a possible wellness outcome from the disease and the main cause of blindness in adults. However, if this is detected and treated early it can significantly reduce your likelihood of blindness, so why the decline?
According to Dr Tara Kiran, a family doctor and researcher at St. Michael’s Hospital and research fellow at the Institute for Clinical Evaluative Sciences in Toronto, ‘Health policy experts suggest that delisting services from insurance schemes can have unpredictable effects’. She notes that ‘Understanding the effect of delisting on care is particularly important as governments face fiscal pressures and contemplate further reductions in what is publicly insured.’
Since November 2004, OHIP doesn’t fund annual eye exams for adults aged 20-64 years, but they are still fully funded for children and seniors. Annual exams are still covered for adults with diabetes, those with other conditions that affect the eyes and people receiving social assistance, yet when the team analysed data on publicly funded eye exams of adults aged 40 and over with diabetes in Ontario, they found that eye exam rates for people aged 40-65 years remained steady at 69% between 1998 and 2004, but dropped to 61% in 2006 and remained low at 57% in 2010.
The authors surmise that this drop was possibly because optometrists were doing fewer exams, and patients and health care providers may not have understood that eye exams done by an optometrist are covered for people with diabetes. There’s also a chance that patients have been inadvertently or inappropriately charged for this service, though the authors were not able to study this.
The authors conclude ‘In this time of fiscal restraint, policy-makers will increasingly debate which services are ‘medically necessary’ and warrant coverage. Some limitations of services may be rational and justified, but policy-makers will need to be mindful of the unintended consequences of delisting services from insurance schemes and the potential impact on health equity. Policy changes need to be accompanied by better and more effective communication strategies to decrease misunderstanding among patients and health care providers.’